Deleterious oral habits, which are persistent, can lead to poor esthetics of a beautiful face. Conventional treatment modalities for an open bite usually include orthodontic treatment and/or skeletal surgery. This article focuses on a different treatment modality for an anterior open bite.

Keywords: Esthetics, habit, open bite, smile

How to cite this article:Parlani S, Patel S. Esthetic correction in open bite. Indian J Dent Res 2011;22:580-2

Dental esthetics plays a key role in the sense of well-being, acceptance by others, success at work, in relationships and emotional stability. [1] Sheets states that, "An impaired self-image may be more disabling developmentally than the pertinent physical defect". [2]

An attractive smile can easily be spoiled due to persistent non-nutritive sucking habit which may result in long-term problems like anterior or posterior open bite, interference of normal tooth eruption and position or alteration of bone growth. If the habit stops before the eruption of permanent incisors most of the changes resolve spontaneously but if the habit persists it may result in long-term problems. Professional evaluation has been recommended for children before the age of three years with subsequent intervention to cease the habit initiated. [3]

Case Report

A 26-year-old male reported in the Department of Prosthodontics, Peoples College of Dental Sciences and Research Center Bhopal, India, expressing the wish to improve the appearance of his anterior teeth in a short span of time due to personal commitment.

There were no significant findings in his medical history, but dental history revealed that the patient had a habit of digit sucking since childhood. On external examination, patient presented with symmetrical face and convex profile [Figure 1]. Frontal view showed that the anterior teeth were in reverse curve and a black space was seen between the maxillary and mandibular anterior teeth, giving an unpleasing appearance, due to which patient was conscious during conversation and smiling. A large anterior open bite was present with proclined maxillary anteriors and class I molar relation on both sides [Figure 2] and [Figure 3].

The treatment objectives for this patient were to correct the appearance, keeping in mind that the patient wanted the dentofacial improvement in a short span of time and in limited expenses too. So it was planned to correct the smile by prosthodontic camouflage i.e. by placing metal ceramic jacket crowns.

Maxillary and mandible full arch impressions with irreversible hydrocolloid impression material were made (Marieflex, Septodont healthcare India PVT. LTD, India). Shade selection was done using a shade guide (Vitapan classical, Vita Zahnfabrik, Germany). Registration of skeletal relations was made with facebow [Figure 4] and the models were mounted in a semiadjustable articulator (Hanau, Waterpik Technologies, USA) to check the incisal clearance during various mandibular movements.

Biomechanical preparation of teeth #12, #11, #21 was done to receive complete coverage metal ceramic crowns. After gingival retraction, final impressions (Zhermack clinical, Confident sales, Italy) were made. Diagnostic wax up was done [Figure 5]. Since the open bite was 8 mm, complete correction of the open bite would lead to, long central incisors in wax-up model. So it was planned to correct the open bite partially, giving 12 mm of clinical crown length of central incisors and lateral incisor in harmony to central incisors. Provisional restorations were given for protection of the vital teeth. Final restorations were fabricated according to diagnostic wax up and cemented [Figure 6] using glass ionomer luting cement (GC fuji I, GC Corporation, Itabashi-ku, Tokyo, Japan).

Open bite can be either skeletal or dental in origin. Open bite, only of dental origin, can be corrected by a prosthetic approach. In the present case, open bite resulted due to interference with normal eruption of incisors because of persistent digit sucking habit i.e. the open bite was purely of dental origin. This condition could have been prevented either by behavior modification techniques or by giving a habit breaking appliance during primary or early mixed dentition age.

Today, every dental practitioner must have thorough understanding of the roles of the various disciplines in producing an esthetic makeover, with the most conservative and biologically sound interdisciplinary treatment plan possible. [4] The present case can be managed orthodontically or by giving jacket crowns. Considering orthodontic approach for correction of such an open bite, the patient had to undergo fixed orthodontic treatment which is not only time consuming but oral hygiene maintenance is also difficult. There are chances of relapse if the patient compliance is poor for retention appliance. Patient desire was to correct his esthetics in a short span of time as his marriage was planned within a month. Therefore, despite good prognosis, orthodontic treatment was not suggested and prosthodontic rehabilitation was the only treatment option left.

While planning the present case it was kept in mind that the most important teeth for appearance are the central incisors, they are generally the teeth most exposed during conversation and usually the focus of attention when an individual smiles or laughs. [5] The unesthetic appearance of the patient was mainly due to the large open bite and proclined maxillary incisors. The open bite was limited to the incisors only and the canines with posteriors were in perfect occlusion.

In the tooth measurement tables recorded by G. V. Black, the average height of a maxillary central incisor was noted as 10 mm with the greatest being 12 mm and the least being 8 mm. [6] Complete correction of the open bite would lead to long central incisors so it was planned to correct the open bite partially, giving 12 mm of clinical crown length of central incisors. The incisal level of #21, #11 and #12 was decided by the incisal edge of #22 and by doing so the reverse curve was corrected, the black space between maxillary and mandibular anterior teeth was reduced and a pleasing appearance was achieved as per the patient satisfaction.

Conclusion

Treatment plan was based on patient's chief complaint. Despite orthodontic treatment being the best treatment modality for such a case, prosthodontic treatment was planned keeping the patient's demand in mind that he wanted results within a short span of time.